JIA Flashcards
What is JIA
Systemic autoimmune inflammatory disorder affecting u16
Can’t tell what arthritis it will turn into
Genetics
Auto-immune
Environment
What is the criteria for JIA?
Age <16
Duration >6 weeks
Presence of arthritis
Joint swelling Morning stiffness Pain / refusal to walk Decreased ROM Tenderness / warmth
System - Rash / fever / fatigue / weight loss
What are the different types of JIA
Pauciarticular <5 joints (55%) -Peristent -Extended - >6 months Polyarticular >5 joints (25%) Systemic Onset / Stills
How do you Dx
No diagnostic test Dx of exclusion ESR elevated ASO titre elevated no strep ANA +ve - pauci RF +ve - poly MSK exam X-ray / USS / MRI
Complications of JIA
EYE DISEASE
Who is affected by pauciarticular Type 1 and what do they present with
Nursery girl <5 Early + gradual onset Limp LL No systemic Sx
What immunological marker is there in type 1 pauci
+ve ANA
Complications of type 1 so what is required
Chronic uveitis
Irregular iris
Routine eye checks
Who typically gets type 2 / late onset enthisitis and what does it present with
School boy >8 years Limp LL joints Systemic rare ANA-ve Iridocyclitis NOT chronic
What is type 2 pauci likely to develop into ?
Hip often affected Spinal pain / sacroiliac tendernes FH of AS May evolve AS / seronegative If HLA-B27 +ve + back = Juvenile AS
Who typically gets Type 3 pauci
Any age
F>M
What is type 3 pauci often known as
Juvenile Psoriatic
What are the symptoms of type 3 pauci
Destructive Asymemetric UL + LL Dactylitis Chronic idiocyclitis FH psoriasis in 40% Pitting, onchylsis HLA-B27
What types of polyarticular arthritis is there
RF -ve and RF +ve
Who normally presents with RF-ve polyarticular
Early childhood
F>M
Affects fast growing joints
What are the symptoms of RF-ve polyarticular
Symmetric arthritis Fever Malaise HSM Anaemia Growth problems If affects TMJ = limited bite and micrognathia
What are the symptoms of Rf
+ve polyarthritis
Similar to adult RA Nodules Fever MAlaise Anameia Erosions on X-ray Sjogren, Felty, Vasculitis
Who normally presents with RF +ve polyarthritis
Late childhood
F>M
Is iridocyclitis common in polyarticular ?
NO it is rare
Who gets systemic onset JIA / Still’s disease
Any age
Present as very sick child
Extra-articular features define
Most serious JIA
What do you typically present with in systemic JIA
Fever for 2 weeks with normal blood culture
Salmon eruption rash accompanies fever
+ve Koebner
What occurs after initial presentation of fever and rash in JIA
Joint arthritis 3-12 months after ever
Only then is diagnosis made
What are other symptoms of systemic onset JIA
Lymphadenopathy Weight loss HSM Abdominal pain IBD \+ve transanimase Uveititis Elevated ferritin Raised CRP/ ESR Raised platelets
Rare Pericarditis Pleural effusion Pulmonary disease Cardiac tamponade
Immunological markers in systemic onset JIA
RF -ve
ANA -ve
